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Radical prostatectomy is the main surgical treatment for prostate cancer and is associated with various short-term complications. Racial and ethnic minority patients have worse postoperative outcomes than White patients following prostate cancer surgery. One of the factors that may contribute to the racial differences in postoperative outcomes is the differential use of new medical technology of robot-assisted surgery (RAS) across racial and ethnic groups. Patients undergoing robot-assisted radical prostatectomy (RARP) have been shown to have reduced short-term complications, length of stay (LOS), and readmissions and comparable long-term survival compared with patients undergoing open radical prostatectomy (ORP). Previous studies demonstrated that racial and ethnic minority patients with prostate cancer were less likely to receive RARP than White patients. However, critical gaps remain in 1) understanding current evidence on racial and ethnic disparities related to RAS in pelvic cancer surgery thoroughly; 2) determining the impact of RARP on racial and ethnic disparities in postoperative outcomes among prostate cancer patients, and; 3) investigating the role of surgeons on the differential use of RARP across racial and ethnic groups. To address these gaps, this dissertation conducted a systematic review to comprehensively understand racial and ethnic disparities in the use of RAS in four major pelvic cancer treatments (prostate, uterine, bladder, and rectal cancers). Following the systematic review, empirical analyses were performed using linked New York State Cancer Registry and statewide discharge records to determine the contribution of RARP to racial and ethnic disparities in the short-term outcomes after prostate cancer surgery, including determining the presence and pattern of interaction between race/ethnicity and RARP use. Based on a multilevel framework, two important hypotheses were also tested to assess surgeons’ influence on the use of RARP across racial and ethnic groups through access to care and the process of care. The systematic review found consistent evidence that Black and Hispanic patients were less likely to receive RAS than White patients in all four pelvic cancer surgeries. There is a lack of formal assessment to determine the impact of RAS use on racial and ethnic disparities in postoperative outcomes. The systematic review also found that racial and ethnic minorities were less likely to receive treatment at RAS-performing or high-technology centers than White patients. But there is a paucity of research examining physician-level factors that may be related to differential use of RAS across racial and ethnic groups. The first empirical analysis detected a statistical interaction between race/ethnicity and procedure approach that was present on the additive scale but not on the multiplicative scale. Specifically, when undergoing RARP rather than ORP, non-Hispanic Black (NHB) and Hispanic men with prostate cancer, as compared to non-Hispanic White (NHW) men, experienced a greater reduction in the risk of adverse short-term outcomes of major events (NHB vs. NHW: RERI -0.32, 95% CI (-0.70,-0.01); Hispanic vs. NHW: RERI -0.28, 95% CI (-0.74,0.09)) and prolonged LOS (NHB vs. NHW: RERI -0.32, 95% CI (-0.70,-0.01); Hispanic vs. NHW: RERI -0.28, 95% CI(-0.74,0.09)) on the absolute risk (additive) scale. The second empirical analysis confirmed the two hypotheses related to surgeons’ role in the racial and ethnic disparities related to RARP use. First, NHB and Hispanic patients were more likely to be treated by surgeons who were low-RARP users (NHB vs. NHW: OR 1.73, 95% CI 1.58-1.90; Hispanic vs. NHW: OR 2.14, 95% CI 1.90-2.41) or by surgeons at non-RARP facilities (NHB vs. NHW: OR 4.26, 95% CI 3.45-5.27; Hispanic vs. NHW: OR 4.01, 95% CI 3.44-4.67) than NHW patients, supporting racial and ethnic disparities in access to care. Second, when treated by the same surgeon and having similar conditions, NHB and Hispanic patients were less likely to receive RARP than NHW patients (NHB vs. NHW: OR 0.73, 95% CI 0.59-0.91; Hispanic vs. NHW: OR 0.72, 95% CI 0.55-0.96), supporting racial and ethnic disparities in the process of care. In summary, this dissertation identified gaps in current literature and showed that NHB and Hispanic patients with prostate cancer were less likely to receive but benefitted more from RARP than NHW patients. Increasing equitable penetration of robot-assisted technology may help reduce racial disparities in patient outcomes after radical prostatectomy. This dissertation also revealed that NHB and Hispanic patients were less likely to be treated by high-RARP-use surgeons and less likely to receive RAPR when treated for similar conditions by the same surgeons than NHW patients. Addressing structural barriers faced by racial and ethnic minority patients during care-seeking and the process of care can help reduce disparities in RAS use.

Mental health researchers have placed a lot of emphasis on the importance of informal social support resources and the effect on mental health outcomes among African Americans to help explain the low rates of mental disorder among this population (Cockerham 2006; Tausig, Michello, and Subedi 2004; Brown, Sellers, Brown, and Jackson 1999). It has been hypothesized that informal social support resources (family, friends, partner/spouse, etc.) used by African Americans (Taylor, Chatters, and Jackson 1997; Neighbors 1985; Stack 1974) buffers/reduces the effect of stress and distress on mental health (Pearlin 1999; Taylor, Hardison, Chatters 1996). In this study I combined the National Comorbidity Survey (NCS) and the National Comorbidity Survey - Replication (NCS-R) data sets to investigate the influence that relatives, friends, partners/spouses, and religious involvement have on levels of depression among African American men and women. I found that there is not much of a gender difference in the experiences of social support among African American men and women. I also found that for the most part social support has the same effect on depression for both African American men and women. Finally, there are no substantial gender differences in the way social support buffers stress for African Americans. / Ph. D.

The dilemma of making education an equitable system, especially for minoritized groups, has persisted for centuries. While there have been efforts aimed at decreasing disparities, there is still more work that needs to be done. An often-overlooked population in science, technology, engineering, and math (STEM) is Black men—a group at the nexus of being a gender majority and racial minority. Thus, the purpose of this exploratory research study is to understand how Black men experience interpersonal relationships in undergraduate engineering programs. The overarching research question that guides this study is: What are the qualitatively different aspects of interpersonal relationships experienced by Black men in undergraduate engineering programs? Using Bronfenbrenner's Ecological Systems Theory as a lens and a quasi-phenomenography methodology to understand the variance of the students' relationships, I conducted 14 semi-structured interviews with students who identified as a Black man and were a second-year or higher in their undergraduate engineering program. By examining interpersonal relationships, I clarify the meaningfulness of relationships at one historically Black college and university (N=1) and two historically white institutions (N=13). A total of seven relationship types and ten different ways students described their relationships were identified in the data. Each of the ways students described their relationship was organized on the emergent domains of academic, emotional/mental, financial, professional, social, and spiritual. Students also mentioned five environmental influences that impacted their experiences in engineering. My results indicate that students find value in relationships with people who were relatable, people who could provide insight or knowledge, and people who showed a sense of care or concern for the student. Students also mentioned how environmental influences bear significance on their over experience in engineering. The present study lays the groundwork for holistically examining the interpersonal relationships of Black men in undergraduate engineering programs. / Doctor of Philosophy / For decades, Black men have experienced educational hardships from as early as first grade. While many researchers have identified areas to improve the educational experience for Black men, few have looked at the educational experience of Black men in science, technology, engineering, and math (STEM). My research adds to the current conversations surrounding Black men in undergraduate engineering programs by looking at how relationships impact their educational experiences. I conducted a research study with 14 Black men in undergraduate engineering programs at two historically white institutions (N=13) and one historically Black university (N=1). I asked Black men about the types of relationships they had and why those relationships were meaningful to them. I also asked the students if there were outside influences such as stereotypes held by society that might impact how they look at their relationships. The students primarily discussed relationships with their STEM peers and professors. Relationships that were more meaningful for students were with people who were relatable, people who could provide insight or knowledge, and people who showed a sense of care or concern for the student. Outside influences that impacted students' relationships were their academic major, the type of institution they attended, their gender, their race/ethnicity, and National events. These findings contribute in several ways to our understanding of the value of relationships and provide a basis for future research involving Black men in STEM.

Five African American fathers participated in a qualitative study that examined how fathers experience their children who live with chronic illnesses. The examination of their strengths and resiliencies revealed 10 factors that enhanced involvement and were incorporated into fathers' overall approaches to parenting: clear paternal definition; strong parenting alliance; gains experienced through father/child relationship; strong spiritual foundation; responsive social support systems; strategies for managing employment and illness demands; confidence in ability to navigate health care structure; attitude of self-sacrifice and flexibility; strategies for managing perceived disparities; and maintenance of future focus. In addition, fathers defined coping and advised professionals involved with families who have children diagnosed with chronic illness. In doing so, they revealed challenges to participation, potential constraints to involvement, and suggestions for productive encounters with systems of care and collaborative exchanges on behalf of children engaged in treatment. / Master of Science

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The problem of not enough African American males enrolling in masters level teaching programs was addressed in this study. This phenomenological study examined the experiences of African American males in master of arts teaching (MAT) programs to understand why they enrolled and what factors led to persistence throughout their program enrollment. Six African American males currently enrolled in MAT programs in the southern, southwestern, and western regions of the United States participated. Data gathered for each participant included an individual, semi-structured interview and a demographic survey. Audio-recordings were used to capture the fullness of the interviews, and transcription software was used to code, analyze, and sort the data to help identify themes. This study looked through the lens of Strayhorn’s graduate student persistence and Albert Bandura’s self-efficacy theories. Factors that influenced African American males to enroll into a program were (a) education as a necessary credential, (b) desire to give back to society, (c) minority scholarship support, (d) making a connection to passion, and (e) desire to enhance teaching skills. External and internal factors were identified as assisting the males to persist within their programs. Academic institutions and policy makers may find the results useful for understanding the unseen educational barriers likely to limit African American males from enrolling in MAT programs, the issues likely to occur during the process of obtaining the degree, and the factors likely to be assistive to them for achieving program completion.

This dissertation was a sub-study of a National Institutes of Health (NIH)-funded randomized clinical trial (R21 NR016112) that examined the effects of resistance training (RT; i.e., weight lifting) on depression in Black/African American (AA) men. The focus of this study was to examine resilience in that population. Resilience is one’s ability to adapt, withstand, and grow in the face of adversity and stress, and it is thought to be inversely associated with stress-related mental illness. Previous research has linked resilience with other intrapersonal factors such as physical self-concept (PSC), and mastery experiences, yet no study has examined the role exercise might play in these relationships. Purpose: To conduct the first study to examine the effects of RT on resilience and PSC, and to explore how mastery experiences might affect these variables. Methods: Twenty-nine participants in the parent study were randomized into either a 12-week RT group or time-matched control. Both groups were required to attend two on-site sessions per week (i.e., 24 total sessions), and all completed questionnaires at three time points (baseline, week 6, week 13). Changes in resilience, PSC, and mastery were analyzed using a series of linear mixed models. Results: There was a significant effect of Time (t = 2.3, p = .02) for resilience, such that the mean score significantly increased by 2.9 points from baseline to the Week 13 in the aggregated sample. There was no significant effect of Group; however, the resistance training group significantly increased their resilience from baseline to Week 13 (p < .01). There was a significant effect of Group (t = 2.5, p = .02) and Time (t= 2.4, p < .01) on PSC from baseline to Week 13. In addition, the results revealed that for every 1-unit increase in PSC from baseline to Week 13, there was a 0.1-point increase in resilience for the aggregated sample. Mastery was not related to any outcome. Conclusion: Results suggest that RT has the potential to influence both resilience and PSC. Furthermore, changes in PSC appeared to be associated with changes in resilience. Future research will be needed to better understand these associations.

Prostate cancer is the most commonly occurring cancer and the second leading cause of cancer death for men in the United States. Because early prostate cancer is frequently without symptoms and data on how to prevent prostate cancer is lacking, early detection has the greatest potential for decreasing mortality. Studies have shown Hispanics/Latinos to be less likely than whites or African-Americans to utilize prostate cancer screening exams. The purpose of this descriptive study was to design a social marketing plan which could be used as a model to promote Hispanic/Latino participation at prostate cancer screenings. Information obtained through medical and marketing literature review, the author's experiences serving on the promotion committee of a community-sponsored prostate cancer screening project, and interviews with 51 Hispanic/Latino prostate cancer screening participants is described and incorporated into a guide with recommendations for future program planners.